Surgical excision of a plunging type of ranula for complete treatment.

1. PLUNGING RANULA
: A CASE STUDY
SERIES

2. PRESENTED BY
DR MANUPRITA AGRAWAL
M S ENT PGT(FINAL YEAR)
MGM MEDICAL COLLEGE, KISHANGANJ
BIHAR
UNDER THE GUIDANCE OF:
DR ALOKE BOSE MAJUMDER
ASSOCIATE PROF.

4. AIMS AND OBJECTIVES
To evaluate the various treatment modalities
for ranula, namely
Total surgical excision by transcervical or intraoral
route
Marsupialisation
Sclerotherapy
To determine the most successful treatment
modality in terms of a long term disease free
state

5. MATERIALS AND METHODS
 Total number of cases : 7
 Injection sclerotherapy : 2
 Intraoral marsupialisation : 3
 Intraoral excision : 1
 Trans cervical excision : 1
Period of study : Oct
2008 to Oct 2010

6. CASE GROUP 1
Initially treated by
multiple injection
sclerotherapy and after
reduction in size, it
was planned for
intraoral excision.

7. CASE GROUP 2
All these
patients
were
treated by
MARSUPIALISATION
only.

8. CASE GROUP 3
All these
patients were
treated with
INTRAORAL EXCISION

9. CASE GROUP
4
TRANCERVICAL
EXCISION OF
PLUNGING
RANULA

10. Patient’s
Name –
Kahkasha
Age – 13
years 6
months
Sex – Female
IPD no.-
14439

11. The Patient
presented with a
soft swelling on
the left side of the
floor of mouth
and SUBMANDIBULAR
region since 3
months.

12. The undersurface
of the tongue shows
bluish cystic
swelling which
swelled up on
compression of the
left submandibular
gland. The
overlying skin was
free from the
swelling and was
non tender. There
was no associated
lymphadenopathy.

13. MRI showing
cystic lesion
on the left
side in the
sublingual
region
extending
into the sub
mental
region,
submandibul
ar region.

14. OPERATIVE
STEPS

15. After
General
Anesthesia
the mass
was
exposed by
a large
submandi-
bular collar
line
incision.

16. Ligation
of the
facial
artery at
the
angle of
mandible

17. The lower part of
the posterior end of
the mass being
freed from the
submandibular
salivary gland and
the digastric
triangle.

18. The whole mass was
slowly separated
from either side of
the mylohyoid
muscle and removed
as a single swelling.

19. THE REMNANT DIGASTRIC
TRIANGLE AFTER THE MASS WAS
EXCISED.

20. THE INCISION
WAS CLOSED IN
LAYERS WITH
INSERTION OF A
CORRUGATED
RUBBER DRAIN.

21. THE POSTOPERATIVE PERIOD WAS
UNEVENTFUL,THE DRAIN WAS REMOVED AFTER
48 HRS.

22. AFTER REMOVAL OF THE DRAIN

23. THE EXCISED MASS
The specimen
was sent for
Histopathological
examination
which later
confirmed the
diagnosis of
RANULA.

24. HISTOPATHOLOGY
Picture of
the excised
lesion
showing
mucin
collection in
the lumen
lined by
connective
tissue with
inflammatory
cells.

25. DISCUSSION
Out of the total treatment modalities for Ranula,
SCLEROTHERAPY only gives partial response by
regressing the cyst volume but no complete
disappearance of the lesion which ultimately
require excision. INTRAORAL
MARSUPIALIZATION is satisfactory but
recurrences do occur between 6weeks to 12 months
with rates as high as 61 to 89%. Although TOTAL
EXCISION of the sublingual salivary gland is ideal
but difficult which can only give long term disease
free survival.

26. REFERENCES
1. Sheng Y.,Zhou J.,Chen Xian-zhi,The First Hospital
of Wuhan,Wuhan 430022;Clinical Analysis of 75
Cases of Ranula,Journal of Oral Science
Research,Feb 2009.
2. Ikarashi T.,Inamura K.,Kimura Y.Kimura,Dept.of
Otolaryngology,Nikonkai Hospital,Japan 1994 ; 114
S511; 196-99
3. Ichimura K., The Journal of Laryngology and
Otology 1996 ; 110 ; 554-56
4. Yoshimura Y.,Obara S.,Kondoh T.,Naitoh S., Journal
of Oral and Maxillofacial Surgery 1995 ; 53:3 ; 280-
82.
5. Tae-Wook Choi,Cha-Kun Oh ; Ear,Nose an Throat
Journal; Health Care Industry,Japan ; Dec 2003

27. ACKNOWLEDGEMENTS
Grateful and Highly Obliged to:
Dr. Dilip Kumar Jaiswal
Dr. B.K.Bhattacharya
Dr. Soumendu Guha
Dr. Alok Bose Mazumdar
Dr. arup sengupta
Dr. santosh raman
MY
FRIENDS,COLLEAGUES,PARENTS….and
my dear PATIENTS.